Autonomy, Informed Consent, & The Law

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The idea of informed consent has evolved over the years along with changes in medical practice.  In the past, medical care was based on paternalism, in which the doctor knew what was best for the patient.  Now, medical care has become more patient-centered as reflected in the informed consent forms patients sign before medical procedures. According to the article, informed consent is when the physician is required to obtain the patient’s consent after disclosing relevant information about the treatment (Liz et al, 299).  However, does that piece of document really represents its definition or does it simply represent the idea of autonomy?

Although physicians are required to disclose relevant information to patients before obtaining their consent, there are also legal standards as to what information must be disclosed.  Legal standards also vary by state.  For instance, “New York requires only that the practitioner provide information about reasonable foreseeable risks and alternative treatments, while the new Georgia statute requires disclosure of the nature of the treatment, any several specified risks, the likelihood of success, practical alternatives, and prognosis if treatment is declined” (Schuck, 916-917).  States have already designated what physicians must disclose to patients.  But does that leave the patient with any real autonomy?  What if the patient would rather not be provided with the information?  Or what if the patient wanted to be disclosed with all material risks?

Health care has increasingly become a legal matter.  Health care providers not only have a moral duty to act in the patient’s interest, but also a legal duty.  Physicians may find themselves in a court case if he or she did not follow state standards.  In Arato v. Avedon, the court considered a claim made by a deceased pancreatic cancer victim’s widow and children that the physician failed to disclose information concerning the statistical life expectancy of pancreatic cancer patients, which violated their duty to obtain his informed consent.  They claimed that if the patient had been properly informed of the high probability of early death, he would not have gone through painful therapies and would have avoided economic losses due to failure to put business and financial affairs into order.  The court eventually ruled that there was no rule of law that mandated the disclosure of specific information like statistical life expectancy (Schuck, 917-918).  This example makes me question how much influence the state has on informed consent.  The law doesn’t always determine what is moral and immoral.  When people think of informed consent, they usually talk about doctor-patient relationship.  I think it’s important to take into consideration what the law says because it greatly affects people’s actions.  In the court case discussed above, the court ruled in favor of the physician but does that mean the patient actually received all the relevant information regarding his condition?  Maybe yes, maybe no.

The law plays a big part in medical practice.  Not only does it tell physicians what they can and cannot do, it can also shape how people view what is considered informed consent.  The law exists to protect the people.  But is it too influential?  Childress states that “the ideal of autonomy must be distinguished from the conditions for autonomous choice” (309).  People can choose who or what to yield to when making decisions.  But does real autonomy exists when the state can ultimately decide what kind of information patients can receive?  Should the state be determining what is regarded as “important and relevant” information or should that be left up to the patients to decide?  Can patients make a real autonomous decision when a third-party can influence what information is given?

Citations:

Childress, James F. “The Place of Autonomy in Bioethics.” Arguing about bioethics. London: Routledge, 2012. 308-316. Print.

Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx, John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing about bioethics. London: Routledge, 2012. 299-307. Print.

Schuck, Peter. “Rethinking Informed Consent.” The Yale Law Journal 103.4(1994): 899-959. Retrieved from: http://www.jstor.org/stable/pdfplus/797066.pdf?acceptTC=true&acceptTC=true&jpdConfirm=true.

Fear of the Law

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The Canterbury v. Spence case brings our attention to the ethical issues of risk disclosure of a medical procedure. This type of case involves and compares the importance of several pillars of ethics: autonomy, benevolence and malevolence. There seems to be a question that is very difficult to answer, and may differ on a case-to-case basis: Does, “every human being of adult years and sound mind has a right to determine what shall be done with his own body…” (an issue of autonomy) trump a doctor acting in the patient’s best interest and avoiding harm to the patient (benevolence/malevolence)? (https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719) It’s convenient to believe that the legal system keeps people on a moral path and helps people make decisions that are ethically sound and in the best interest of society as a whole. But in some cases, fear of the law may cause more issues than it does good.

Risk of a procedure is not the only type of information that doctors potentially keep from their patients. There is also the issue of disclosing errors that may have occurred during the process of a patient’s care. According to an article in Ghana Medical Journal (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/) doctors often do not tell patients or their families when an error has occurred, whether it be in surgery or anything else related to the patient’s health care. Instead, the doctors and institutions tend to try and cover up these events to avoid legal issues. In this case, the doctors are putting their own well being above that of their patients. According to the report, healthcare errors lead to more deaths than motor vehicle accidents, breast cancer or AIDS in the US. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/).

Putting your life, or the life of a loved one in the hands of a human, capable of error, is an act of immense trust. The article refers to the doctor-patient relationship as fiduciary; “one who owes to another the duties of good faith, trust, confidence and candour”. This is trusting the doctor to act in best interest of the patient. However, can a doctor do that if he is worried about the consequences of an error? If he puts his own well being before that of the patient’s?

In class, we have talked about the importance of intention in ethics. When it comes to health care and medicine, if someone’s life is at stake, people tend to care less about intention and more about the outcome. If an error results in a patient’s death, the family cares little about the doctor’s intention to do good, the focus is on the error that resulted in death. This is the responsibility and punishment that the doctor must shoulder as a casualty of his daily work.

Here we have two different types of disclosure: risk disclosure before a procedure, and disclosure of any errors after a procedure. For the first, the law helps to encourage doctors to share all possible complications with the patient, to avoid lawsuits should anything go wrong. For the second, the threat of the law dissuades doctors from disclosing human error events that may have occurred. This would lead us to the assumption that doctors’ morals are rooted in fear of the law rather then intrinsic human nature.

However, this is not always the case. Like in the Canterbury v. Spence case, doctors sometimes choose to not share some information that they believe may do more harm then good. They take the risk of the potential lawsuit in their effort to do what they believe is best for the patient. In this case, the doctor is putting the patient’s well being above his own. So which is more important, the patient’s autonomy or the doctor’s duty to do what he feels is best for the patient?

 

Citations

Edwin AK. Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Med J. 2009;43(1):34–9. [PMC free article] [PubMed] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/?report=classic

Informed Consent: Opinion Canterbury v Spence https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719 Physicians’ obligations and patients’ rights.

 

Blame House

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People love to watch the heightened drama of the emergency room and hospital from the comfort of their own couch. They do not have to deal with the emotional stress nor feel faint from the physical sight of blood. All they see are attractive, smart doctors treating patients with ease. But this glamorized medical world is far from reality. Seldom to people recognize the moral dilemmas of medical treatment and professionalism depicted in popular medical television shows like House, M.D. and Grey’s Anatomy.

Faculty from the John Hopkins’ Berman Institute of Bioethics analyzed depictions of bioethical issues and professionalism over a full season of Grey’s Anatomy and House, M.D. and found that “the shows were “rife” with ethical dilemmas and actions that often ran afoul of professional codes of conduct” (Nauert). Informed consent was the most frequently witnessed bioethical issue. In the total of 49 cases, 43 percent were cited as “exemplary” consent, meaning that the depictions portrayed a balanced discussion with the patient about possible treatment options, and the remaining cases were classified as “inadequate” (Nauert). Inadequate depictions involved hurried, one-sided discussions and refusal of physicians to answer patient’s questions, sometimes even complete disregard for the informed consent doctrine (Nauert).

Occasionally, dismissal of informed consent seems justified by positive outcomes, as seen in the following clip from Grey’s Anatomy, when an autopsy is conducted on a deceased patient without the family’s consent: https://www.youtube.com/watch?v=0hgNQni0xdw. However, this is how the screenwriters wanted the situation to play out. In the real world, serious repercussions would obviously accompany the doctors’ rash decision.

While television’s impact on us is limited, it still has an influence on our expectations and beliefs about the world around us. It has shaped our perceptions of many careers like law enforcement and forensic science; medicine is no different. A previous study conducted by one of the co-authors of the article, found that more than 80 percent of medical and nursing students watch medical dramas on television (Nauert). What exactly are aspiring doctors learning from these shows? How do various depictions of ethical issues shape their moral perception of every day patient encounters?

As previously mentioned in other blog posts, physicians do not think informed consent is an “integral part of good patient care” (Lidz et al, 303). Perhaps the popular medical dramas are to blame.

Citations:

Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx, John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing about bioethics. London: Routledge, 2012. 299-307. Print.

Nauert, Rick. “Ethical Failures Found on ‘Grey’s Anatomy’ and ‘House'” LiveScience. TechMedia Network, 30 Mar. 2010. Web. 17 Feb. 2014. http://www.livescience.com/6240-ethical-failures-grey-anatomy-house.html

Canterbury v. Spence

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The opinion in Canterbury v. Spence provides a great opportunity for discourse on the patient’s right to informed consent, which sometimes opposes what the physician may think is best for their patient.  Just as soon as there is a rule regarding guidelines to informed consent, there is bound to be an exception to that rule.

 

As this case so clearly demonstrates, it is far from uncommon for a physician to be sued for malpractice in the event that something has gone wrong.  Because of this constant threat, one might think that doctors would be completely on board with informing their patient as thoroughly as possible, if only to prevent cases like Canterbury v. Spence from happening.  While ideally the fear of malpractice suits should not be the only factor motivating physicians to fully inform their patients, it may be a good starting point.

 

While Dr. Spence claims to have withheld the information because he had the patient’s wellness in mind, it seems reasonable that Canterbury may have been better served by being completely informed.  When a minute but potentially significant risk is involved, it may be better to over share, especially if the patient is of sound mind, as Canterbury allegedly was.  At that point, the patient has all the cards in his hand and makes a fully informed decision. This would also bring into account the relationship between the patient and physician. Ideally, the physician would be able to inform the patient of all potential risks and still trust that the patient would have enough faith in the physician’s educated opinion on what the course of action should be, as the doctor is clearly more well-versed on current medical practice.

 

An interesting point that O’neill brings up in his article “Some Limits of Informed Consent,” is how problematic informed consent can become when relating to issues of public health policy.  The examples he gives are those of water purity levels and food safety requirements.  It is simply not feasible to adjust these levels or regulations to individual choice, and it is unreasonable to assume that each individual would have the knowledge necessary to make a decision like that. The reason we have professionals who devote their lives to this field of study is for precisely that reason, and for the most part, we do well in trusting their expertise.

 

 

Bibliography

O’neill, O. “Some Limits of Informed Consent.” Journal of Medical Ethics 29.1 (2003): 4-7. Print.

 

Knowledge is Power

It’s rare to come across someone who refuses to hear information that is offered. In general, people want to know everything—whether it is ordinary gossip or their medical conditions. Therefore, there are many patients who desire informed consent because they want to know the details and reasons behind the medication they are assigned to take.

Informed consent is when a physician is “obligated to obtain the patient’s consent” and to “disclose relevant information about the treatment before obtaining consent and beginning treatment” (Lidz et al, 299).  However, nowadays, the doctor-patient relationship gap has widened and, as a result, there’s a lack of communication between the two. So, “physicians do not often fully inform” and “patients do not fully understand” because the doctors don’t have the time and/or desire to make those connections with their patients (Lidz et al, 299). So, while the patients should have an input on their medical decisions, it’s really the physicians who make them (Lidz et al, 299).

Time is of the essence. The time the physician has with his patient is limited, so the medical situations are treated as an event as opposed to a process. Lidz and his colleagues said: “medical decisions are processes that emerge and evolve over a period of time, not discrete events that occur only once” (Lidz et al, 300). However, usually, informed consent is given to a patient at a time where the medical decision is already made. For instance, when I was a freshman in high school, I needed knee surgery. I did not know what the surgery entailed until that day. I had an idea of what anesthesia was but I didn’t know exactly how it worked until I was about to go into the surgery room and my anesthesiologist started explaining to me what was going to happen. I remember thinking how fast-pace the process was. While she put the IV in me, she quickly asked me questions about any allergies to anesthesia and quickly explained to me how the medicine worked and how my body was supposed to react. At this point, I was already going into the operating room and even if I did not want to, I had to go through with it.

Though this example may be miniscule, I think it’s extremely important for one to be informed about their medical situation if they want to be. Though time is the main issue, I think it’s important for the physician himself to, at least, summarize a patient’s situation and give him or her a broad idea of the medication the physician is giving them. Additionally, it may be necessary to even discuss the side effects or why alternative medicine is or isn’t possible. However, unfortunately, physicians don’t think that informed consent is an “integral part of good patient care” (Lidz et al, 303) so they don’t make it a point in their limited time to discuss medical details that, perhaps, they should share with their patients.

Patients should be informed. Though the physician should share information, I think it’s up to the patient to ask questions so that they are knowledgeable and, therefore, make decisions for themselves. In The Place of Autonomy in Bioethics, Childress says that the principle of respect for personal autonomy includes being competent, informed, and acting voluntarily (Childress, 309). We should want to have respect for our personal independence by being knowledgeable.

 

Works Cited

Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx,
John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing
about bioethics. London: Routledge, 2012. 299-307. Print.

Childress, James F. “The Place of Autonomy in Bioethics.” Arguing about
bioethics. London: Routledge, 2012. 308-316. Print.

Communication is Key

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People, in general, only want to be communicated with and to know the risks associated with any procedure—be it medical or not. Personally, I believe that doctors should communicate normal risks found with procedures. If there are rare, but life threatening risks, the doctor should mention them out of courtesy, but it should not be required of the doctors. However, I also believe that it is unrealistic for doctors to communicate all of the rare risks associated with said procedures. Patients should research the procedure or medication prior to consenting to it, this way the patient will be able to ask well thought out questions. Because this should be happening, it means that patients need to be aware of what the doctor suggests with plenty of time to research and become used to the idea. Lidz points out that often patients are not fully aware of the procedure and risks until the night before. Perhaps having a group of professionals at a hospital or health care center to fully explain risks and benefits to patients is what is needed. Instead of placing full responsibility on the doctor or nurses, maybe explanations need to be delegated to a special staff trained in communicating with patients.

Patients also need to understand that any medical procedure is unnatural and all procedures carry risks, some more serious than others. It is also important to keep in mind the possible benefits of medical procedures and to weigh the risks and benefits. Because this takes some experience, doctors should clearly explain and give their personal recommendation. Because patients generally do not understand medical terms, it is important for doctors to communicate in simple, everyday terms. This is a barrier that Lidz hints at, but never fully comes out and states. This barrier is one between the knowledge of doctors and the knowledge of patients.

In a way, failing to adequately inform patients of risks is comparable to the food industry failing to inform consumers about the genetically modified food which has been shown to cause health problems. I use this example because, similar to informed consent, it is a topic that is often overlooked. In general, people only want to be aware of risks associated with anything that goes into their body. It is when they unknowingly take medications with severe, common risks that they become reasonably upset.

An interesting blog, written by Dr. Bernstein, brings up the issue of informed consent of “the level of resident participation.” Most patients consent to having a resident on the team during surgery, but often are unaware of how involved the resident is. According to the statistics found in the blog, “consent rates decreased from 94.0% to 18.2% as the level of resident participation increased.” Again, communication between doctors and patients is key to a well working environment to benefit everyone the most.

In conclusion, informed consent has evolved a great deal in the last century. However, there is still room for improvement.

 

 

M. Bernstein. (2013, September 16). Patient Informed Consent for the Teaching Hospital “Trainee” Care: Informing Realistic Scenarios. Retrieved from: http://bioethicsdiscussion.blogspot.com/2013/09/patient-informed-consent-for-teaching.html

Lidz, C. W., Meisel, A., Osterweis, M., Holden, J. L., Marx, J. H., Munetz, M. R. Barriers To Informed Consent. In S. Holland, Arguing about Bioethics (299-307). New York: Routledge.

Relationships with Doctors and Patients

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Informed consent is general information distributed to each patient. Despite the efforts made by the consent forms to notify the patient of the risks of the procedure, the content of the forms are often disregarded. The questions then rise with how detailed should the content forms be. Should the debriefing of the dangers of the procedure be mainly done by the doctor or should the information be strictly attached to the form. I believe that there should be a combination of both. The patient should be informed about the severity of their surgery through the form, and the doctor should warn the patient about the basic risks of the procedure. Although not as overlooked as Terms and Conditions, the consent forms do serve a pertinent purpose for both the patient and the doctor. The goal here is to communicate to the patient the general risks of the procedure. However, then the question is what exactly should not be shared? Should the doctor discuss the rare cases that may occur with the procedure or not? I believe that the doctor should try to translate medical terms to lamest terms, but they don’t have to go in depth on rare cases unless it is fitting to their condition. I also think that the time information is conveyed should also be a concern. They should be given enough time to contemplate whether they would like to continue with the procedure or not. The patient and doctor should both be held responsible to effectively communicate with each other their concerns with the treatment. If communication is not present then there will be a disconnect with the information given.

When thinking about how the patient is informed, we must also consider the doctor and patient relationship. Some doctors aren’t personable, but establishing a healthy connection between the doctor and patient is pertinent. When this relationship is formed, it builds trust. Also, the doctor becomes more understanding of how the patient feels generally and about the surgery.  As a result, the doctor would have the patients’ best interests at heart. According to Schumann, establishing a patient doctor relationship has therapeutic purposes and is one of the main goals for a doctor during practice.

As stated in the text by Lidz there were four reasons that patients desired information: “Information of Compliance, Courtesy, Veto, and Decision making”. The reasons are understandable, and the patient has a right to this information. Some patients assume that the doctor simply knows what they’re doing, and will do what is best for them. However, Lidz made a great point that out of respect for the person patients want to be informed. The relationship between the doctor and patient would contribute to the degree of courtesy and amount of information that is disclosed. People are unique and respond differently to information when communicated.  However, the patient must also question the doctor about certain issues they have. They also have a duty to ask the doctor about certain things that would affect them that the doctor may not be as informed about. The decision of the procedure should ultimately be a combination of the doctors expertise and how the patient feels. Quite naturally, there will be things that the patient does not understand about the procedure, but it is the doctor’s duty to inform the patient as much as possible with sufficient information prior to the procedure.

References

Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.

Kegley, Jacquelyn Ann K. “Challenges to informed consent” EMBO reports, 2004. 832-836.

Suchman, Anthony L. M.D., Matthews, Dale A., “What Makes the Patient-Doctor Relationship Therapeutic? Exploring the Connexional Dimension of Medical Care”.  American College of Physicians. 1988; 108; 125-130.

The Limits of Informed Consent

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The autonomy of the patient has triumphed, in legal terms at least. Doctors and health care personnel are legally required to disclose information about treatments to patients, and patients have the legal right to say “yes” or “no” to any treatment. But how practical is informed consent? The legal implementation of informed consent seems to be mostly a matter of filling out extra paperwork. So that seems practical enough. On the other hand, actually practicing the moral values behind informed consent is much more difficult.

We value the freedom to choose on so many levels. We have a right to choose as consumers, as voters, as citizens and as competent people in general – so then why not as patients? Of course patients should have a right to consider multiple opinions, assess alternative treatments, and then make a choice on their own. But in reality, a patient’s autonomy is highly limited. A lot of the limiting factors are neither inconsequential nor easily avoidable. In Barriers to informed consent, Lidz et al. outline how patient trust, physician expertise, acute illnesses, and complex medical systems make true informed consent difficult to achieve.

Are we morally obligated to try to overcome these obstacles? Or can they be viewed as the practical, real-world limits to our abstract ideals of patient autonomy? This question isn’t really about obstacles like access to healthcare or the complexity of the healthcare system. There’s no question that we should be trying to increase access to care and streamlining the system. The interesting obstacles are those that deal with the doctor-patient relationship. Should we be trying to change this relationship on a moral basis?

Let’s consider patient trust and physician expertise – both important obstacles to informed consent. Patients often don’t really want to make a decision based on what they know about their medical condition. They instead trust the physician enough to make such decisions for them. I see this as a clear act of autonomy. It’s a very rational choice to trust a trained professional’s informed decision over one’s own, likely less-informed decision. Ah but that’s where physicians have to make sure patients are fully and objectively informed, right?  Well even if a physician explains the relevant diagnosis and treatment to the patient in an easily comprehendible way, most patients will not know the essential mechanisms and pathology behind the physician’s decision. They’ll instead be given a simplified picture of a complex system – one that is inevitably going to be biased towards the physician’s decision anyway. We can’t blame physicians for such simplified, biased explanations any more than we can blame scientists for being biased towards one particular theory or paradigm. In the words of Galileo, “it is not within the power of the practitioners of demonstrative sciences to change opinion at will,” (p 125). They are compelled to believe what they believe by the power of reason.

All of this is not to say that the “informed” part of informed consent is irrelevant just because it is likely to have a bias. But maybe the information is, for practical considerations, less important than what we call patient trust – a form of rational consent.

Sources:

Galilei, Galileo, and Maurice A. Finocchiaro. The Essential Galileo. Indianapolis, IN: Hackett Pub., 2008. Print.

Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.

Net Positive Externalities from Genetic Enhancements

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As a society, we praise those who are exceptional, whether it be intellectually or musically talented, athletically gifted or artistically genius. Part of this is sheer awe of their talent, but also part is because of the positive externalities they have on our society. Those who make great discoveries in math or science often help us to understand the way the world works and these discoveries can also be used for medical discoveries. Great athletes provide entertainment for those who watch them compete and also can inspire young athletes to strive to train harder and be better. Even those who are not classified as “exceptional” can benefit society. It is relatively clear that having a smarter population helps society as a whole and the same goes for a healthier population; whereas having a taller population or a prettier one does not. When discussing transhumanism (H+) and genetic enhancements it is important to focus on the enhancements which would benefit the individual and society rather than only the individual.

While the main argument of many opponents to genetic enhancement is “If the gap between the privileged and the underprivileged continues to grow, wealth-based access to health care and future genetic enhancements will threaten the basic structures of society” (Mwase, 88), this is a not a valid argument as to why genetic enhancement should not be allowed. “[The] increase in unjust inequalities due to technology is not a sufficient reason for discouraging the development and use of the technology. We must consider its benefits, which include not only positive externalities but also intrinsic values that reside in such goods as the enjoyment of health, a soaring mind, and emotional well-being” (Bostrom, 113). Also it is not clear that (at least to begin with) genetic enhancements would increase inequality, but might actually decrease it. One of the greatest benefits of the discovery of the human genome is the ability to understand genetic disorders. While many genetic disorders are extremely complicated, there are over 4000 genetic disorders which are the result of a defect in a single gene (News Medical). While today we are still trying to figure out how to fix many of these defects, it seems likely that this will be a much easier problem to solve than how to enhance something such as memory or health where multiple genes play a role. This seems to indicate that, minimally, initial genetic enhancements would decrease the inequality gap rather than widen it. Also, in the same fashion that most countries provide free public education and many free accesss to health care, it would make sense for governments to provide free or reduced cost genetic enhancements to those who can not afford the enhancements if they have a net benefit to society.

While there are clearly issues with genetic enhancement that need to be flushed out as they become a more realitic options, enhancements which have positive externalities should be allowed in theory.

 

Work Cited.

Bostrom, Nick. “Human Genetic Enhancement: A Transhumanist Prespective.” Holland, Stephen. Arguing About Bioethics. New York: Routledge, 2012. 105-115.

Mwase, Isaac M. T. “Genetic Enhancement and the Fate of the Worse Off.” Kennedy Institute of Ethics Journal (2005): 83- 89.

News Medical. http://www.news-medical.net/health/Single-Gene-Genetic-Disorder.aspx. 8 February 2014.

Informed Consent: It is your Pick.

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In the past decades, the doctrine of informed consent has slowly changed the medical practice form “paternalistic standard” to a more “patient centered” standard of care. Today, the topic of informed consent has become a center of controversy because it hardly remains what its original purpose was. When the idea of patient centered standard was first introduced after the historical case of Canterbury vs. Spence, Judge Robinson based his decision on one key point: “Autonomy rights” in which the patient has a right to participate in the decision making process of his own medical treatment.  In his decision, Robinson specified that the burden to educate the patient is on the physician; prior to any medical procedure, the physician should disclose to the patient, not only the nature of the procedure, but also the associated risks, alternatives treatments and potential benefits of the procedure. Hence, the primary aim of the informed consent was to involve and educate the patient about his own health care, and foster a dialogue between the physician and patient towards future treatment possibilities. However, today, the process of informed consent has lost its educational segment and is merely seen as a  process of signing a legal “release” in case of medical negligence.  This shift in the ideology of the process has caused both the physicians and patients to suffer and has hurt the entire medical profession in a big way.   Over the years, patients have become confused and paranoid about the whole informed consent practice and, ironically, by adding possible negative outcomes on the consents, physicians themselves have educated patients of many more medical liabilities than they were previously aware of. Today, patients feel the victims of the informed consent process, and many have lost respect for the medical field in general.  This is due to the fact that most informed consent processes are there to protect the interests of physicians and surgeons, and hardly any protect the patients and meet the needs of their families.

In order to regain the true essence of the informed consent, based on patient-physician trust, Physicians need to provide their patients with the proper information they need to know so that they also understand the possible consequences of their treatments. The ideal decision making process, according to Lidz et, al, should have four elements:  1. Information is disclosed to patients by their physician, 2. Physicians make reasonable efforts to explain the procedure to the patient and make sure that patient understands the procedure completely, 3. Patient makes the decision for or against the procedure, 4. Patient makes the decision willingly. In a New York Times article: Treating Patients as Partners, by Way of Informed Consent,  thttp://www.nytimes.com/2009/07/30/health/30chen.html?pagewanted=all, Dr. Eric D. Kodish,, chairman of bioethics at the Cleveland Clinic, said, “the choreography of informed consent, [is about]  how you make eye contact, sit down, build trust.”  Is it still possible to rebuild this trust based on mutual honesty, for solely ethical and medical reasons?

References

 Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972).

Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.

Chen, Pauline. “Treating Patients as Partners, by Way of Informed Consent.” The New York Times. N.p., 30 July 2009. Web. 10 Feb. 2014. <http://www.nytimes.com/2009/07/30/health/30chen.html?pagewanted=all&_r=0>.

“Informed Consent.” Cagle Post RSS. N.p., n.d. Web. 9 Feb. 2014. <http://www.cagle.com/tag/informed-consent/>.